Transcript Occupational Health Services in eleven countries – who are

Occupational Health Services in eleven countries
– who are they?
* Contribution to Health for All?
* Contribution to business development?
*Contribution to an inclusive working life?
* Problems ?
A survey of Occupational Health Service organizations of
Austria, Czech Republic, Denmark, Japan, Finland, France,
Germany, Netherlands, Norway, Sweden, UK and UK/Scotland
Special Issue of ”Policy and Practice in Health and Safety”
Chief Editor: David Walters
Guest Editor: Peter Westerholm
Occupational Health Services in UK (Lawrence Waterman)
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Problem – 8 % of private sector companies use some form of OH support. 2.5
mill. people on incapacity benefit in 2005.
OH preventive services a patchwork quilt of public and private providers with
widely varying approaches and service quality
NHS tasks diagnosis and treatment – not prevention
Strong professional bodies of OH safety and health advisers (occupational
medicine, occupational hygiene etc)
Indications of traditional approaches in OH being largely ineffective. More of
the same not likely to improve situation
In 2000 key documents of HSC intentions – ”Revitalizing health and safety” and
”Securing health together” demonstrating OH issues of central importance and
providing basis for broad-based, multi-skilled team approach in addressing
issues such as risk assessment, fitness for work and the rehabilitation and
return to work of workers in ill health
In 2001 establishment of Programme Action Group to follow up ”Revitalizing”
targets
Birth of the OH Support model to be described as Workplace Health Connect by
the HSE
UK (Lawrence Waterman) - Workplace Health Connect –
programme (HSE 2005)
• A confidential service designed to give free,practical advice on
workplace health, safety and return to work issues to smaller
businesses in England and Wales
• An adviceline and supporting website – giving tailored practical
advice to callers, both managers and workers, on workplace health,
safety and return to work issues
• A service that aims to transfer of knowledge and skills directly to
managers and workers enabling them to tackle and solve issues
themselves
• Set up in partnership with HSE and based around
Adviceline/website and problem solving services available locally
• Bottom line messages
- OH too important to leave to doctors
- Health is not divisible – healthcare is at its best holistic
- To prevent harm is good, to promote wellbeing is even better
Developments in professional OH - UK /Scotland
(Ewan B. Macdonald & Gabe Docherty)
• Taking the UK government programme ”Work, Health & Wellbeing –
caring for our future” one step further
• Scope of OH professionals work tasks widened beyond traditional
workplace perspective to cover all population of working ages
• National OH Director appointed to implement Work, Health and
Wellbeing strategies
• Center for Healthy Working Lives established for coordination of OH
activities
• Healthy Working Lives action plans to be implemented on a large
scale
• NHS/Scotland to support development of free advisory OH services
to SME:s in industry
• Free Workplace visit, confidential Risk Assessment, WPHP needs
assessment,
OHS/The Netherlands – development from a professional
to a market market regime (André Weel & Nico Plomp)
• First period 1920 – 1980 – Medical OH services. Drive from large
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industrial corporations and government to arrange medical services
for workers
Second period 1980 – 1994 – Multidisciplinary OH services.
Services became advisory bodies with an enlarged scope of tasks.
Legal and economic experts on boards of management. Occupational
physicians, occupational hygienists, safety engineers and
organizational advisers on service teams.
Third period 1994 – 1999 Commercial services. Service units
transformed into business organizations. New commercial OH
providers emerging and sharp competition on health market.
Insurance companies and private investors enter stage as owners
Fourth period 1999 – 2006 Lost monopolies Incentives to invest in
rehabilitation and prevention strengthened. Return to work
programmes and sickness absence management in demand by client
companies.
OHS France – on the rails from occupational medicine
towards occupational health (Gabriel Paillereau)
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Arrangement of access to OHS services at compulsory for employers
(who pay the costs)
Dominant role of OH physician as advisor in all OH matters and
adaptation or development of working conditions.
Heavy load of annual medical examinations of all employees for
assessment of work ability
Cardinal changes following a Government decree of July 2004:
- medical examinations reduced to examinations every second year
- OccupPhysicians dominance challenged in introducing a new
professional category – ”occupational hazard prevention operative”
- Occupational Health Plan 2005-2009 implying strengthening of
surveillance and monitoring functions and establishing new
administrative central and regional structures for these tasks
- Planning of regional multidisciplinary research centres
Transformation has caused and is still causing a good deal of heat
OHS Finland (Matti Lamberg, Kaj Husman & Timo Leino)
- the cornerstones
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Government development strategy for OHS during 2002 – 2015
OHS objectives to promote health and work capacity, to increase
attractiveness of working life, to prevent and treat social exclusion
and to provide functioning services and reasonable income security
Employers obligation to organise and pay for preventive services for
all workers. This may be done in different ways
Employers are reimbursed for up to 50 % of approved OH service
costs from sickness reimbursement funds
OHS main tasks to prevent work-related illnesses and accidents, to
raise level of health and safety at work, to improve health, working
ability and functional capacity of employees at all stages of their work
careers, to promote the functioning of the work community
Legislative regulation of management and surveillance of national
plan and subsidiary plans addressing vocational training, competence
development matters and research
Finnish OH system based on firm political determined commitment
OHS Denmark – Rise and fall of preventive services (Anders Kabel,
Peter Hasle and Hans-Jörgen Limborg)
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Before 2001, OHS organisations/units provided services oriented
towards OH needs of prevention. Basis: Employers legal obligation.
Structure: Bipartite management of service units. Requirements of
competencies and a quality system with programme for evaluations
After 2001, consequent to post-election change of government :
- obligation of employers to organise OHS affiliation annulled
- OH surveillance to be enforced by Labour Inspectorate issueing
notice for improvement.
- Notices for improvement may include referral to OH service units for
assistance in complying with requirements of Labour Insp.
- Companies with a Danish certificate on work environment or British
OHSAS 1800 are exempt from inspections
Earlier OHS units may be authorised to provide consulting services on
Working Environment issues. On market also others offering similar
type of services.
Consequences: Significant decrease of OHS service units in market
and availability of OH professionals
OHS Sweden - Example of OHS unit Programme Document
- Chief Occup. Physician Johnny Johnsson, StoraEnso Inc. Forss,
Sweden)
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Prevention of work-related disease and illness
Promotion and restitution of health
Development of the working environment
Improvement of work capacity, motivation and
performance of staff
Supplement – jontly with company Safety Dept
• Support of business activities and strategies for
Human Resource Management
• Client orientation and generation of added value for
the company in general
OHS in European countries
– an ETUC view (Laurent Vogel)
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OHS systems of Europe display wide differences in legislation and
practices
From trade union point of view many OHS systems do not deliver
services matching expectations placed on them. Situation sometimes
described as a Crisis of Confidence
Coverage patchy - in most countries well below 60 % - excepting
countries with legislative requirement for full or almost full coverage
(Ex. Netherlands, Belgium, France, Finland, Luxembourg)
Large groups not provided OHS : SME´s, workers in insecure jobs,
unorganized labour etc
Multidisciplinarity - only modestly developed. Nordics, UK + Spain
Quality of OH preventive services often uncertain. Its surveillance
inadequate
Reservations regarding OHS professional independence
Reservations regarding professional competence of external
consultants and expertise in Occupational Health subject matter
Reservations regarding collaboration and contacts between workers
and preventive services
OHS Professionalism – regardless of setting
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To have a Health agenda
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To be evidence-based or, at least, evidence-informed, in action and in all
assessments
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To be aware of stakeholder expectations
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To help solve practical problems
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To communicate on OH issues with management, employees and trade unions
and with other OH professionalsas appropriate
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To act in alignment to principles of Occupational Health ethics
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To take all opportunities in contacts to a life-long learning process
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To be transparent in all action and asessments
The Doctor’s Leadership Paradox
• A physician does not really need a boss at all
• If there should happen to be a boss anyhow, it must be
another physician
• “Bosses” only do un-important, administrative things
• Colleagues who become “bosses” are no longer real
physicians
• However, all physicians want to be bosses and have a
highly developed sense of hierarchy….
Source: Chief Physician Carola Lemne MD
Hospital Manager of Danderyds University Hospital
Karolinska Institutet, Stockholm
PW_IOSH_Cardiff May 2007
”A handshake should not go beyond the elbow”
African proverb – Quoted by Godfrey B Tangwa,
Yaounde University, Cameroon
OHS – some features with implications for
professionalism
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OHS actor in a welfare system of considerable complexity with high
dependence on other actors in concerted efforts
Multiple stakeholder scenario in which no individual stakeholder is a
priori regarded as most important of all
Challenges on evidence based or research based knowledge and
insights
The three common models of guiding and managing human activity –
hierarchy, market and professional networks - exist in parallel
Three domaines in co-existence – OH professionals, management –
including management of OHS organisations – and the domain of
industrial relations. The demarcations of accountability and
responsibility may become blurred all too easy.
OHS work carried out in an ethically complex and demanding context
Health professions globally involved in re-negociation of their societal
and market targeted contracts
Well trained graduates of universities pouring out and entering all
sectors of labour market - including the health sector
Some determinants of OHS future
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Commitment and governance of the state with regard to OHS?
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Role models of OHS organisations. Agents of public health?,
Commercially based organisations in a health market?
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Required competencies of OHS organisations in meeting expectations
of the state or those of clients in the market?
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Conception of service quality and its development in OHS. Whose
quality? Quality of customers/clients ? Quality as understood by
health professionals? Quality implying cost-efficiency ?
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Implications of market mechanisms in OHS organizations operating as
market actors?
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Strategies for evaluating the effectiveness and health impact of OHS?
Professionalism
is to be visible
and to inspire
trust
This is it
Thank you for your attention !!!
Peter Westerholm